Korean J Transplant.  2022 Nov;36(Supple 1):S25. 10.4285/ATW2022.F-1196.

Efficacy of remote ischemic preconditioning in living donor renal transplantation: a randomized controlled trial

• Tiwari V
• Rana DS
• Gupta A
• Bhargava V
• Chadda S
• Malik M
• Gupta A
• Bhalla AK
• Pawar N

• KMID: 2535173
• DOI: http://doi.org/10.4285/ATW2022.F-1196

Abstract

Background
In kidney transplantation ischemia reperfusion injury (IRI) is an inevitable complication. However, paradoxically, an additional injury occurs upon reperfusion which limits the amount of tissue that can be salvaged. Limiting this injury can increase patient and graft survival and can decrease complications associated with transplantation.
Methods
Eligible participants were adults (>18 years) undergoing transplantation. The intervention group received RIPC half an hour before undergoing transplantation. The RIPC procedure consisted of four cycles of 5 minutes inflations of the standard blood pressure cuff on the upper arm to 40 mm of Hg above systolic blood pressure followed by 5 minutes of deflated cuff peri-od (reperfusion period). The control group did not receive any intervention before the operation. The efficacy was evaluated as the proportion of patients achieving a 50% decline in serum creatinine level at 72 hours after transplantation and oliguria (<400 mL/day) on days 1, 2 and 3. Secondary objectives were creatinine at 3 months of transplantation, acute rejections and delayed graft function.
Results
At the end of 3 months, 58 patients in the RIPC group, and 52 patients in the control group were analyzed. All patients showed a >50% decline in creatinine level at 72 hours of transplant. There was no oliguria in the first 3 days. Delayed graft func-tion was present in 3.8% of cases in the control group and 1.7% in the RIPC group (P=0.7). The mean serum creatinine level in both groups was the same at 3 months (1.2 mg/dL vs. 1.08 mg/dL, P=0.5). Slow graft function was present in 17.3% in the con-trol group while 10.3% in the RIPC group (P=0.1). Acute rejections were similar in both groups (5.2% vs. 7.1%, P=0.8).
Conclusions
RIPC has no beneficial effect on urine output and graft outcome in renal transplant patients.